The Cytology Laboratory evaluates specimens from various body sites for the detection of cancer, precancerous changes and other benign conditions. It is located in the Department of Pathology on the third floor of the Hospital Expansion Building, rooms 3001 and 3035 A-D. The laboratory is open from 0730-1630, Monday through Friday. Cytology Laboratory telephones for general inquiries and FNA requests are manned from 0800-1630, Monday-Friday. For patient specimen results, contact Laboratory Customer Service at 924-LABS, option 2 (0700-1900, Monday-Friday).The Cytology Laboratory Tube Station (831) is operational from 0800-1600, Monday-Friday.

Cytology specimens are delivered via the tube system to Central Receiving for the Medical Laboratories. They will be forwarded to the Cytology Laboratory during working hours or stored until the Cytology Lab is open. UNFIXED specimens that cannot be delivered to the laboratory within 1-2 hours after collection should be refrigerated (BUT NEVER frozen) until delivery can be made.

All non-gynecologic specimens or rush gynecologic Pap tests received in the laboratory by 1530 are processed and read the following work day. Specimens sent after that time must wait for processing until the next work day unless special arrangements are made with the laboratory technical staff or laboratory director. Bronchial lavage specimens arriving in Central Receiving after regular laboratory hours on Friday or on Saturday will be processed and read as a part of the Monday workload. Inpatient GYN Pap tests are read within two working days of receipt. Results on non-gynecologic cytology specimens are available within two working days of receipt in the laboratory. Routine GYN Pap tests are processed and read as quickly as possible. Results are usually available within five to seven working days of receipt in the laboratory.

"STAT" specimens are defined as all specimens that require processing and reading outside of normal laboratory workflow. Results are usually available on STAT medical specimens within twenty-four hours (excluding weekends and holidays) of receipt of the specimen in the laboratory. STAT Pap test results are available within two working days of receipt of the specimen. When diagnostic results on cytology specimens are needed outside of the routine laboratory turn around times (i.e., same day, weekends, holidays), the request should be made directly to the technical staff of the Cytology Laboratory in order to obtain appropriate approval for the request. Such requests will be granted only in cases of critical need. Special arrangements available for bronchoscopy material are discussed later in this Cytology Laboratory section.

Specimens submitted for cytologic evaluation must be collected and submitted in the manner described in the Laboratory Handbook and Test Directory available on-line. Only appropriate glass or hard plastic containers with tightly sealable, screw-top lids are acceptable for submitting specimens (except conventional gynecologic Pap smears and ThinPrep Pap Test). Conventional gynecologic Pap smears are typically spray or drop fixed and placed in a special slide holder (supplies available through Laboratory Customer Service). The ThinPrep Pap Test has a unique collection kit available from the hospital storeroom. The use of proper containers is essential to protect hospital and laboratory personnel from exposure to infectious agents due to inadequately or improperly packaged specimens. Persons submitting specimens should carefully review the instructions for the desired test prior to collecting the specimen so that all necessary criteria can be met, and an optimal specimen reaches the laboratory.

Specimen containers must be appropriately labeled with two patient identifiers: the patient's name and history number or date of birth. If multiple specimens of various types are submitted on the same person, each specimen container should also be labeled as to the specimen type. If specimens are submitted on glass slides, the slides must be labeled with the patient's name at the site of collection. All specimens must be accompanied by a preprinted Cytopathology Request Form or a printed Epic order. The form must contain all pertinent data including:

Patient's name, history number, date of birth

Name of attending physician requesting test (not a resident or fellow alone)

Clinic, ward, or service generating the specimen

Type or source of specimen, date of collection

All pertinent clinical history or other data relating to the requested evaluation

ICD-10 code documenting the reason the test is being performed.

This information is essential for the efficient processing and correct evaluation of the cytologic material. Acknowledgment of receipt of specimens into the laboratory is indicated by the laboratory time/date stamp.

The policies described here are in accordance with the requirements for submitting all laboratory specimens as listed by Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the CLIA (Federal) regulations. These requirements clearly state that it is the responsibility of the physicians requesting laboratory tests to submit the item in the prescribed manner and to provide certain basic information concerning the patient and the specimen.

All questions concerning cytology specimens should be directed to the Laboratory Manager or General Supervisor in Cytology Laboratory.

CRITERIA FOR SPECIMEN REJECTION

The laboratory reserves the right to reject specimens that are submitted in an improper manner. Criteria for rejection include:

*Inadequate identification of the specimen container or slides

*Vital information not given on the cytopathology request form (e.g., type of specimen, patient name or history number, patient location, date of collection, etc.)

*Unacceptable packaging of the specimen

*Improper fixation of the specimen

*Requested test not performed in the laboratory

*Specimen from an unauthorized source

*Absence of appropriate ICD-10 code.

When problems occur, the physician, clinic, or floor that generated the specimen is contacted as soon as possible so that the error(s) or deficiency can be corrected. Minor problems of missing or conflicting information may be handled over the telephone. However, such specimens will not be processed until the problem(s) is resolved. For major problems of specimen identification, fixation, or packaging, the submitting physician/location is contacted, and the specimen is NOT processed unless the specimen is determined to be "precious." (Refer to Health System Policy #83 Medical Laboratories Specimen Acceptance/Rejection Criteria). Problem specimens are retained in the laboratory until contact with the specimen source can be made.

No specimen is discarded without the permission of the laboratory supervisor, manager, or director. The submitting physician or service is notified by telephone when the decision is made to discard a specimen.

Bronchoscopy specimens (biopsies, washings, brushings) received in the Cytology Laboratory before 1530 will be processed for reading on the following workday. Specimens on inpatients arriving in Cytology after 1530 (Monday-Friday) will be processed for reading on the following workday only if the necessary laboratory personnel are available. As many specimens as possible will be processed; however, some specimens may have to wait until the next work day for processing. Priority will be given to the biopsy specimens. This late processing is not available on outpatient specimens. To assure next day reading (excluding weekends and holidays) of all submitted specimens, they must arrive in the Cytology Laboratory by 1530 each scheduled workday. If requested, bronchial lavages and biopsies from inpatients that are processed on Friday by the Cytology personnel are read on Saturday morning by the appropriate resident and attending in Surgical Pathology. Results will be called to the clinician when all studies are completed.

Same Day Processing

Same day processing with interpretation is available on regularly scheduled workdays (Monday-Friday, except holidays) for bronchoalveolar lavage (BAL) and bronchial biopsy specimens ONLY for critically ill, respiratory compromised patients (e.g. immunosuppressed or transplant patients in crisis). Specimens collected on weeknights (except Friday) are sent to Central Receiving. They will be delivered and processed the following morning and read by the end of the workday. All specimens MUST arrive in the Cytology Laboratory by 0900 in order to meet processing deadlines. Specimens that arrive after that time will be processed and read the following workday (including Saturday morning reading). The test request form should clearly indicate that Same Day Processing is required, give adequate clinical information about the patient and the specimen, and include the name of the clinician to whom the results should be reported as well as a PIC number or extension where he/she can be reached.

Weekend/Holiday Processing

Bronchoalveolar lavage specimens from critically ill, respiratory compromised patients obtained on weekends (1700 Friday through 0700 Sunday) or on certain holidays will be processed and read by the Anatomic Pathology resident on call. Only specimens that are collected on a day followed by a CLOSED day in the Cytology Laboratory (e.g., Saturday, holiday weekends) will be processed by the resident. Specimens collected on a day followed by an OPEN day in Cytology (e.g. Sunday) will NOT be processed by the resident. They will be handled by the Cytology staff on the following workday (refer to instructions for same day processing previously discussed).

The clinician performing the bronchoscopy should notify the Anatomic Pathology resident on call (PIC 1264) as soon as the decision to do the procedure is made regardless of when the procedure will actually be performed. This will allow the resident to make the necessary arrangements for the processing and interpretation of the material. After the specimen is collected, it should be delivered directly to the Anatomic Pathology resident. Do NOT deliver the specimens to Central Receiving unless directed to do so by the Anatomic Pathology resident.

Each specimen must be accompanied by a separate test request form with complete patient information and clinical data recorded on it. The form should also indicate the name of the clinician to whom the results should be reported and a PIC number or extension where he/she can be reached. Results on all specimens will be telephoned to the appropriate clinician as soon as all studies are completed.

Bronchial biopsy specimens are NOT typically processed on weekends and holidays. They will be handled by the Cytology Laboratory staff on the next scheduled workday (refer to instructions for same day processing). However, they can be processed in cases of extreme critical need. Discuss the case with the AP Resident on-call (PIC 1264).

SPECIAL INSTRUCTIONS FOR THE COLLECTION OF BODY CAVITY FLUIDS

When a large volume of fluid (greater than 1000 mL) is obtained, allow the cellular material to settle in the bottom of the collecting container, and then gently pour off the excess supernatant. Agitate the remaining fluid to resuspend the sediment and pour into an appropriate specimen container. In general, the quantity of specimen sent should not exceed 800 mL.

Submit the specimen in a tightly covered glass or hard plastic container with a screw-top lid. Volumes of fluid 200-800 mL may be submitted in brown plastic 24-hour urine collection containers. Soft plastic collection bags and E-Vac containers with clamped tubing ARE NOT ACCEPTABLE for submitting body fluids for cytologic evaluation. They are difficult to handle for processing and tend to leak in transit, which can cause contamination of the tube system as well as causing a health hazard to hospital and laboratory personnel. Secure the specimen for transport at the site of collection to avoid accidents.

Refer to the earlier section on submitting specimens to the Cytology Laboratory for additional information regarding applicable procedures for specimen collection and submission.